Last week, I received a very distressed call from the devoted wife of one of my patients, a man with progressive memory problems and difficulty making sense of the words he hears. A treatable but painful medical problem had forced him to visit his local hospital’s emergency room. The staff there refused his wife the opportunity to accompany her husband to the examination room. They cited pandemic-related policies meant to reduce patient and staff exposure to infection by limiting the presence of visitors. Such policies are widespread during these stressful and risky times. When my patient’s wife was finally allowed to join her husband, though, she was horrified to see that he’d signed a document he couldn’t understand and accepted a “do not resuscitate” designation that didn’t match his true wishes.
Although this extreme example of disrupted communication reflected a misunderstanding of a hospital policy that was not intended to be so restrictive, there is no doubt that the policies reducing our risk of Covid19 infection have disrupted, as an unintended “side effect”, the essential human links that allow us to feel connected, safe, and close. Everyone is affected by this, and social distancing precautions place a special burden on our vulnerable older adults.
“Older adults” are by no means all alike. When we group together healthy, working individuals in their 60’s with potentially frail centenarians we are taking a demographic shortcut that conceals more truth than it exposes. Age is only one of many factors that describe an individual, and we would not be likely to generalize about “children” as a group that includes everyone from newborns to adolescents. But putting that important warning aside, we can still talk in a meaningful way about some basic shared human needs that affect older members of our society in a special way.
Social distancing is necessary now to protect all of us, especially vulnerable individuals, and our older population is at greater risk than younger people. Due to age-related changes in their immune systems and the presence of chronic heart and lung diseases, many older adults are at increased risk for catching Covid19 if exposed, and at greater risk for a poor outcome or death once infected.
But social distancing comes with a cost. The emergency room visit disaster described above was an error, but genuine policies have created similar situations in other settings. Hospitals have restricted visitors, outpatient medical and dental offices have limited companions, and long term care facilities have enforced various degrees of isolation, in some cases restricting contact with family to digital communication or “window visits”. Health care and many other types of social interaction now routinely take place virtually, in a cyberspace that is less accessible to many older adults who did not grow up with these communication options, never mastered them, or now lack the capacity to understand them.
For many older adults, connections with family, friends, and health care providers are a lifeline feeding practical and emotional needs. Let’s all make an effort to recognize their plight! Take the time to teach a grandparent how to connect digitally with their friends and family. Recognize the stress that your elders are under and be considerate if they show frustration or anxiety. Keep alert to the appearance of depression, which is the most common antecedent of suicide in older adults. And consider helping an older relative get needed help and evaluation if you see signs of memory failure or confusion. It’s our responsibility to show compassion and provide assistance to those who, in their younger years, assisted us!
Guest Blogger: James M. Ellison, M.D., M.P.H., The Swank Foundation Endowed Chair in Memory Care and Geriatrics, ChristianaCare; Professor of Psychiatry and Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University; Editor in Chief, Journal of Geriatric Psychiatry and Neurology
James Ellison MD MPH is the Swank Foundation Endowed Chair in Memory Care and Geriatrics at ChristianaCare in Wilmington, DE. As a geriatric psychiatrist, his primary interests are in understanding and addressing the mental health concerns of older adults.